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Magnification and illumination are meaningless unless a dry operative field is present.  It is only under this circumstance that  a spine surgeon can then apply their sophisticated skills.  Because neural and non-neural tissues (dura, scar tissue, etc.) can often not be reliably discriminated with the naked eye alone the use of enhanced illumination and magnification is necessary under all conditions and is essential under particular circumstances (i.e. the repair of dural tears).  
 

Courtesy FultonJ: "Harvey Cushing":
A Biography, Charles C. Thomas, 1946		 Pioneer neurosurgeon Harvey Cushing shown operating in Boston in 1929 did not have the benefit of modern illumination and magnification.  Attached to his head is a bare light bulb.  In addition to being a poorly focused light source Dr. Cushing's assistants frequently suffered the occupational hazard of skin burns when he turned his head. 
 
The state of the art in illumination during the Professorship of Walter Dandy at Johns Hopkins Hospital was chronicled in this drawing by founding medical artist Max Brödel. 
   
It wasn't until 1967 that a fiber optic surgical headlight was developed by Burton to replace the bare light bulb.  This new headlight, (U.S. Patent 3,645,254) was designed by the Editor, during his experience as a United States Navy neurosurgeon.
 
Since 1967 fiber optic headlights have been in common surgical use.  Shown here is a 9x operating telescope model produced by Designs for Vision.  For routine spine surgery a 4.5x telescope with a 18" focal length and wide-field is typically considered to be optimal.  
 
The introduction of the operating microscope in the late 1960-1970s for the purpose of microsurgical nerve repair and small blood vessel anastemoses initiated a new surgical dimension.  Shown here is a Carl Zeiss, operating microscope.  As with all innovations the optimal areas of application and inherent liabilities have emerged only with the passage of time.
 
  Microscope Advantages   

Excellent illumination and visualization for a limited field of vision.
Allows assistant to observe procedure.
Allows for video monitoring.
 
  Microscope Disadvantages   

Increases surgical cost.
Increases surgical time.
Increases likelihood of infection.
Limits surgeon visualization of full operative field.
For routine use in spine surgery the Burton Experience has been that the combination of a fiber optic headlight and operating telescopes are superior to the operating telescope.  When operative complications such as dural tears occur the failure to utilize adequate magnification and illumination with a full field of vision has often resulted in unnecessary patient problems.